title: Cost-effectiveness of primary prevention of paediatric asthma: a decision-analytic model.
abstract: BACKGROUND
  Many children stand to benefit from being asthma-free for life with primary (i.e., prenatally started) prevention addressing one environmental exposure in a unifaceted (UF) approach or at least two in a multifaceted (MF) approach. We assessed the cost-effectiveness of primary prevention programmes for Dutch children in a decision-analytic framework.
  
  
  METHODS
  A decision-analytic tree model analysing healthcare costs and asthma cases prevented was developed to compare usual care (UC) with two UF and three MF programmes on the primary prevention of asthma amongst children. Programmes were evaluated through incremental cost-effectiveness ratios and net monetary benefits. Decision and parameter uncertainty were subjected to value-of-information analyses.
  
  
  RESULTS
  The current UC and one of three MF programmes dominated the other alternatives. The MF programme was more costly but also more effective than UC at an incremental cost-effectiveness ratio of <euro>8,209.20/additional asthma case prevented. The value of perfect information to reduce uncertainty was <euro>291.6M at its lowest. Most of the uncertainty in the cost-effectiveness threshold was attributable to the probability and cost estimates for low-risk children.
  
  
  CONCLUSIONS
  This study supports the feasibility of a structured programme that simultaneously addresses exposure to house dust mites, pet dander, environmental tobacco, and breast-feeding as a cost-effective alternative to UC in the primary prevention of asthma amongst children.
authors.affiliation: Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, feljandro.ramos@gmail.com.
authors.forename: G Feljandro P
authors.initials: GF
authors.lastname: Ramos
authors.forename: Antoinette D I
authors.initials: AD
authors.lastname: van Asselt
authors.forename: Sandra
authors.initials: S
authors.lastname: Kuiper
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Tanja
authors.initials: T
authors.lastname: Maas
authors.forename: Edward
authors.initials: E
authors.lastname: Dompeling
authors.forename: J André
authors.initials: JA
authors.lastname: Knottnerus
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
mesh_terms: D001249:Asthma / Q000191:economics / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008390:Markov Chains; D011322:Primary Prevention / Q000191:economics* / Q000379:methods